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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳欣宏 | 合併骨盆底電刺激及局部陰道動情激素對更年期婦女膀胱過動症之治療效果: 隨機對照試驗研究 | 2016/7/28 下午 05:56:44 | 0 |
| 原 文 | 題 目 | 合併骨盆底電刺激及局部陰道動情激素對更年期婦女膀胱過動症之治療效果: 隨機對照試驗研究 |
| 作 者 | Abdelbary AM et al | |
| 出 處 | Urology | |
| 出版日期 | Sep;86(3):482-6, 2015 | |
| 評 論 |
目前對於膀胱過動症的主流治療還是以藥物為主，另外也有無侵入性的骨盆底肌肉收縮訓練或低侵入性的電刺激(經陰道或肛門)治療，甚至較侵入性的肉毒桿菌注射治療可以選擇，但對於更年期婦女膀胱過動症患者應該選擇哪種治療模式最適當呢？本文是一篇隨機對照試驗研究(RCT)，作者收集2010到2014共315位更年期婦女(平均年齡48.5±6歲)，將她們平均分成三組，A組只接受經陰道骨盆底電刺激治療(每次30分鐘，每週兩次共12次)，B組則只接受局部陰道動情激素乳膏治療(每天2g)，C組則給予前面兩種合併治療；然後分別於治療後第1週，及第3、6個月追蹤其治療成效。 結果發現，3組在開始治療後都有顯著進步，但急尿(urgency)症狀改善程度C組比A、B組更好(P=0.00，0.009)，而尿失禁(incontinence)改善程度則是A、C組比B組更好(P=0.005，0.004)；此外，3組病患在追蹤6個月後症狀都有變差的現象，卻唯獨C組在尿失禁改善部分可以繼續維持效果。作者認為局部陰道動情激素治療可能可以改善陰道局部組織狀況，進而增加電刺激治療時電流的傳導效能，以及改善骨盆底肌肉對電刺激的反應等因素有關。 當然，這篇RCT的研究仍然可能有些缺點，例如：追蹤時間太短，沒有合併口服藥物治療組及缺少安慰劑對照組的比較等等，同時也必須依賴更多大型及更久的臨床研究評估才能定下結論。但合併電刺激與局部陰道動情激素乳膏治療，的確可以減少藥物服用及其合併的副作用，以及有效改善病患生活品質的優點，應當可作為更年期婦女膀胱過動症病患一個可以優先考慮的治療選項。 |
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| abstract |
OBJECTIVE: To evaluate the efficacy of combined vaginal pelvic floor electrical stimulation (PFS) and local vaginal estrogen in treatment of female overactive bladder (OAB). MATERIAL AND METHODS: This is a randomized controlled trial carried out on 315 perimenopausal females with OAB who were randomly allocated into 3 equal groups. Group A underwent PFS using vaginal probes twice weekly for 12 sessions. Group B received local vaginal estrogen, as group C received both PFS and local estrogen. All patients were evaluated by a voiding diary, quality-of-life questionnaire, vaginal examination, urine analysis, blood sugar, ultrasonography, and urodynamic study before and after therapy. Patients were followed up 1 week, 3, and 6 months post-therapy. The analyzed variables included day and night time frequency, incontinence episodes, urgency, quality of life, detrusor overactivity), and functional bladder capacity). Outcome measure was urge incontinence. RESULTS: Within each group, there was a statistically significant improvement in all variables after treatment. Improvement of urgency was better in group C than in groups A and B (P = .000, .009). Improvement of incontinence was better in groups A and C than in group B (P = .005, .004). Follow-up showed worsening of symptoms within 6 months in all groups except incontinence in group C. CONCLUSION: Vaginal PFS and estrogen found to be effective in treating OAB symptoms in perimenopausal females. Estrogen seems to augment the effect of PFS especially in the treatment of urgency incontinence and can delay its recurrence. |
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